In the past two years, Kyle Scudiere, 32, has completed four bike-run duathlons and five triathlons. Not bad for a former self-confessed slug—and someone managing relapsing-remitting multiple sclerosis (MS), which is marked by symptom flare-ups followed by remission. “I was lazy in high school,” admits Scudiere with a chuckle. By his late twenties, Scudiere had gained weight and had recurring back problems. He started running and eventually competed in distances up to 10K (6.2 miles). In 2023, when he started training for the New York City Marathon, he began experiencing muscle spasms, spasticity, loss of sensation, and numbness. “My legs would lock when I tried to walk,” he says. Problems with his legs, extreme fatigue, loss of balance, and temperature dysregulation led him to a neurologist, who diagnosed him with MS.
Once he was able to walk again thanks to high doses of intravenous steroids, the muscle relaxant baclofen, physical therapy, and the immunosuppressant natalizumab (Tysabri), and with the encouragement of his neurologist, Scudiere got back to running. Then he transitioned to training for a triathlon—an event that involves running, biking, and swimming. His devotion to the sport means Scudiere, who lives in Port Jefferson, NY, trains all year long. When the cold temperatures increased his muscle spasms, he shifted 80 percent of his training indoors. Now in the winter months he runs on a treadmill, uses a stationary bike at the gym, and swims in an indoor pool.
Little research has been published about how cold weather affects people with neurologic conditions. That prompted Joseph H. Friedman, MD, FAAN, a professor of neurology at Brown University Medical Center, to investigate the association. He and a colleague, Nahid Mohammadzadeh, MD, interviewed 151 people with Parkinson's disease about their exercise routines and learned that cold temperatures increased tremors in those who had them. Results were published in Parkinsonism & Related Disorders in May 2023.
Other clinicians say they hear these concerns about cold weather from their patients—and a corresponding reluctance to stay active in the winter weather—often. “I anticipate hearing that every year around this time,” says Natalie P. Witek, MD, a movement disorders specialist with the Advocate Medical Group in Park Ridge, IL. “I joke with my patients that I wish insurance would cover trips to someplace warm.”
Dr. Witek says the finding does not surprise her. “We know that nerve firing is slower in cold weather,” she says. Plus, she adds, “people, especially older patients, many of whom have arthritis, just don't feel as comfortable in the cold in general.” By contrast, in people with MS, nerve firing slows in hotter weather, says Barbara Giesser, MD, FAAN, a neurologist at the Pacific Neuroscience Institute in Santa Monica, CA.
Cold temperatures may be uncomfortable for those with neurologic disorders because their internal thermostats may be unable to adjust properly. “Our bodies are meant to maintain a set point, or homeostasis,” says Michael Jaffee, MD, FAAN, associate professor of neurology at the University of Florida in Gainesville. “One way the body adapts to keep warm is to contract the muscles,” he says. With a neurologic condition, the communication between nerves and muscles can be disrupted. Blood vessels also constrict to reduce heat loss, which may shift circulation away from hands and feet. “These changes our blood vessels make in cold weather also affect certain neurologic conditions, like peripheral neuropathy, and can make symptoms worse,” says Dr. Jaffee.
Despite these obstacles, doctors say it's important for everyone, not just those with neurologic disorders, to remain active year-round. Evidence shows that exercise, especially high-intensity exercise, not only reduces symptoms of Parkinson's disease but also may slow its progression, says Joseph Jankovic, MD, FAAN, professor of neurology at Baylor College of Medicine in Houston.
And there are additional benefits, says Dr. Jaffee. “Staying active preserves brain health, increases physical fitness, maximizes quality of life, and improves balance to help prevent falls,” he says.
To accrue these benefits, people need to be consistent with their physical activity. It's important to recognize the challenges of exercising in cold weather, says Dr. Jankovic, but “there's nothing about warm or cold weather that should prevent patients from continuing their exercise.”
The first precaution for lower temperatures is to dress appropriately, says John Castellani, PhD, a research physiologist who studies cold-weather performance at the U.S. Army Research Institute of Environmental Medicine in Natick, MA. “You want a relatively thin layer against the skin that can wick moisture away,” he says. That could be a polypropylene type of material or silk. The second layer should insulate you by trapping air. Look for fleece or natural fibers like wool, he suggests. Add a repellent third layer to keep off wind and rain. “It's typically lighter and could be a nylon jacket or vest.” Add a ski cap or fleece beanie, lightweight socks made from moisture-wicking material, and insulated gloves, he says. “If you keep your core temperature warm, you'll have good blood flow to the hands and feet,” Dr. Castellani says.
Michael Hall, a New York bodybuilder and runner who was diagnosed with MS in 2003, wears an outer shell with pockets. “If I have to take off my hat or gloves because I'm too hot, I have a place to put them,” says the 56-year-old.
If exercising outdoors for 30 to 60 minutes four or five times a week still sends a shiver down your spine, you do have an option. “Exercise indoors,” says Dr. Jaffee. “You can get the benefits of exercise without having to go through all those adaptations to the cold. I'd rather my patients get the right amount of exercise indoors than have a briefer period of exercise outdoors.”
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